Service Delivery and Implementation
DOI link for Service Delivery and Implementation
Service Delivery and Implementation book
There is substantial variation in long-term care policy and market characteristics, both within and across states. This variation is refl ected in differences in the policies that state and local governments adopt, say, with respect to Older Americans Act programs, state-only funded initiatives, and, of course, Medicaid, whether in relation to provider regulation, payment, eligibility, benefi ts, or overall spending (Feinberg et al. 2004; Ng et al. December 2012; Howard, Ng, and Harrington December 2011; Kitchener et al. February 2007; Miller 2002; Synder et al. November 2012; Reinhard et al. September 2011; Woodcock et al. June 14, 2011). This cross-state variation is also refl ected in differences in the demand and need for care, for example, the number and proportion of chronically ill and frail elders, adults with physical and developmental disabilities, and children with special health care needs, as well as differences in the need for government assistance, perhaps as best indicated by the unemployment rate and proportion of individuals at or near the poverty level (Synder et al. November 2012; Reinhard et al. September 2011). This cross-state variation is further refl ected in differences in the supply of service providers, whether family caregivers (Arno 2006), nursing home operators (Harrington et al. June 2008; Harrington et al. October 2011), assisted living/residential care facilities (Mollica September 2009; Stevenson and Grabowski 2010), home care agencies (CMS April 2011), adult day care centers (Rosato, Lucas, and Howell-White May 2005), home health and personal care aides (Seavey and Marquand 2011), and options for transportation and housing (Farber et al. December 2011). The costs of care vary substantially as well (Metlife Mature Market Institute November 2012; Reinhard et al. September 2011).